St Matthews Unit

St Matthews Unit is a care home providing personal and nursing care to 46 people with a diagnosis of dementia and/or mental health at the time of the inspection. The service can support up to 52 people.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: Overall the management of risks associated with people's care and support had improved. People had strategies which provided guidance in the event they became distressed. However, wound and pain management needed to improve at the service. We found concerns in relation to the management of medicine. For example, the provider did not always have written instructions for staff about the reasons for giving people when required medicine.

People were mainly supported to have maximum choice and control of their lives and staff mainly supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported by enough staff to meet their individual needs and to pursue hobbies and interests in their local community.

Right Care: Staff knew people well and used people's preferred communication methods, however, care plans were still being updated and improved to support staff to provide person-centred care. Staff had received additional training around people's health conditions and responses and interventions for people who experienced distress. The range of activities had not increased since our last inspection, but people were going out when they wanted to.

Right Culture: Improvements had been made in provider oversight and governance systems. Our evidence identified that improvements needed more time to fully embed into working practices. The provider had learnt lessons from our previous inspection findings and been open about where things had gone wrong. A new manager had been appointed. Relatives and staff were positive about changes, including improved communication and consultation.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 29 July 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The last rating for this service was inadequate (published 29 July 2022). The service has been rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

This service has been in Special Measures since 29 July 2022. During this inspection the provider demonstrated that improvements have been made.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken a number of actions during and following this inspection to mitigate the risks identified at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Matthews Unit on our website at www.cqc.org.uk.

Enforcement

This service has been in Special Measures since 29 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Matthews Unit is a care home providing personal and nursing care to 55 people with a diagnosis of dementia and/or mental health at the time of the inspection. The service can support up to 58 people.

People’s experience of using this service and what we found

Systems and processes were not always effective in ensuring the safety of people. Audits completed had not always identified and mitigated risks to people. Concerns found in previous inspections had not all been rectified or mitigated.

People were at risk of harm from known risks. There were not always risk assessments or mitigating strategies completed for risks associated with water, fire and environment. We found concerns relating to all three of these areas.

We could not be assured physical interventions were completed safely. Records did not contain sufficient information and not all staff involved in physical interventions had the necessary training. The provider had failed to identify when staff or managers had not followed the providers procedures on physical interventions.

Staff were not always adequately trained. We found some staff did not have up to date training in safeguarding, manual handling, communication and food and fluids. Rotas and records did not always record the name of staff on shift or completing a specific task. Staff had received adequate training to understand and know the correct techniques to be used when physically restraining people.

People were supported to have maximum choice and control of their lives, however, staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had made improvements in the way they recorded and reported injuries sustained to people and investigated to establish the cause of the injury.

The provider had a dependency tool and allocated sufficient staff to each shift. Staff were recruited safely.

People received their medicines as prescribed. Medicine records were well kept and contained up to date and detailed information. Staff were trained and assessed in medicine management.

Staff wore appropriate personal protective equipment (PPE) and cleaning schedules evidenced the home was regularly cleaned. The environment had been adapted for people including the use of dementia friendly signs, sensory walls and radiator and pipe covers.

Care plans contained details of people’s emotional, physical, cultural and personal needs. People’s medical and health needs were met, and referrals were made to healthcare professionals as required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 April 2021) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risks, physical interventions and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspection is detailed at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Matthews Unit is a care home providing personal and nursing care to 55 people with a diagnosis of dementia and/or mental health at the time of the inspection. The service can support up to 58 people.

People’s experience of using this service and what we found

Systems to protect people from abuse required improvement. Injuries and when staff used physical intervention had not always been recorded, investigated or audited.

Risks to people had not always been identified, recorded or strategies put into place to reduce these risks. The environment required some improvement.

Cleaning records had significant gaps in the recording of tasks and not all areas of the home were clean.

Staff did not fully understand the legal framework around restraint. Staff had not received adequate training to understand how and when to physically intervene.

Systems and process in place to maintain oversight of the service required improvement.

People were supported by staff who knew them well and who had been safely recruited. People told us staff were ‘kind and cheerful.’

People were able to access food and fluid as they wanted. There were ‘hydration stations’ throughout the building and people told us the food was good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff read people’s care plans which detailed their communication, religious and support needs. When people required support from healthcare professionals, staff referred or supported people to access this support.

People, relatives and staff were able to feedback on the service and knew how to complain if needed.

The provider and registered manager sent an action plan outlining the strategies they were implementing to mitigate the concerns found on inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Published 31 October 2017)

Why we inspected

We received concerns in relation to safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Mathews Unit on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to risk assessments, safeguarding and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

An unannounced quality inspection of St Matthews Unit was carried out on 30 and 31 August 2016 by the Mental Health Act (MHA). Since the inspection, the regulated activity assessment or medical treatment for persons detained under the Mental Health Act 1983 has been removed from the provider’s registration and the service had ceased to be a hospital.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments addressed specific areas individual to each person using the service. Staff understood their responsibilities to safeguard people from abuse and knew how to raise any concerns if they suspected or witnessed ill treatment or poor practice.

The Recruitment systems were robust to make sure the right staff were recruited to keep people safe. There was enough competent staff available with the right mix of skills to meet the needs of people using the service. Systems were in place for the ordering, receipt, storage, administration and disposal of medicines.

Staff received training that was relevant to their roles and responsibilities, ensuring they had the skills and knowledge required to support people effectively. Capacity assessments had been carried out for all people using the service, the assessments identified where people required help to make decisions, and where they lacked the mental capacity to make particular decisions. Deprivation of Liberty (DoLS) applications had been submitted to the local authority as required.

People were supported to maintain a healthy diet and have access to healthcare services in response to ill health and had routine health checks. People had developed positive relationships with the staff. The staff protected people's privacy and dignity and advocacy services were available for people if required.

Detailed care plans in place, they contained information about people’s needs and aspirations and short term goals. People were encouraged to develop their independence and were supported to follow their interests and hobbies. The staff knew how to support people when they became anxious through using individual coping strategies. Systems were in place to receive and take appropriate action to address any complaints.

Established quality assurance systems were being used to monitor the service to continually drive improvement.

People we spoke with told us that they were happy with the service and liked living at St Mathew's unit. They also told us that staff were friendly and supported their needs.

During our observation we noted that people's relatives provided positive comments about the home and the level of care that was given by staff to their family member. Some of the comments included "Seems to have a good relationship with all staff and they are great to him', and 'I am pleased he is here and they have settled in well'.

Several people were not able to hold meaningful conversations with us, but we saw from their responses and body language that they were happy with the way staff were supporting them. We observed that all staff on duty had a calm and kind manner when working with individual people.